Application Of The Clinical Reasoning Cycle & Principles Of Patient Centred Care

This assignment will discuss the author application of the clinical reasoning cycle and principles of patient centred care together with evidence based literature on developing a nursing management plan for 8 hours following Mr P's admission to the ward.From the given scenario, the author has listed 7 potential nursing problems by using the best method which is the clinical reasoning cycle. The Clinical Reasoning Cycle ensures all health care professional to assess and discuss steps to facilitate decision-making, enabling the clear formulation of a care plan (Levett-Jones, et al., 2010).

The first problem identified would be risk for intra-cerebral hemorrhage (ICH) related to falls as evidenced by Mr P who received 8 stitches over a laceration on his forehead post fall and elevated blood pressure. This is evidenced by the raise in blood pressure (BP) levels that is very common after ICH and it results from the combination of multiple factors including pre-morbid hypertension and increase intracranial pressure (Willmot M, Leonardi-Bee J &Bath PM, 2004).

The second problem identified is the risk for septic shock related to fall, high heart rate and urine retention as supported with old age and premorbid congestive cardiac failure. This is evidenced on the high heart rate reading where the immunity of the body is fighting against the infection by pumping hard for blood flow to damaged organs and the kidney being the most targeted organs in sepsis, particularly since it’s so sensitive to changes in blood flow and pressure, it is not uncommon for your urine to be affected (Longo DL, et al., 2015).

The third problem identified is high risk for deep vein thrombosis post fall secondary to old age and congestive cardiac failure This is supported by prolonged bed rest as patient has movement limitation together with pre-morbid congestive cardiac failure which causes poor heart and lung function which decreases the body blood flow and being older than 60 years increases risk for deep vein thrombosis (DVT)(National Heart, Lung, and Blood Institute,2017) Hospital stays are almost twice as long in elderly patients who are hospitalized after a fall and that of the risk for DVT than those who are admitted for another reason.( (Dunn, Rudberg, Furner & Cassel, 1992)

The fourth problem identified is pain related to fall and right hip fracture as evidenced by complaints of moderate pain on admission.

The fifth problem identified is risk for pressure ulcer due to fall. High risk for pressure ulcers affects mostly elderly individuals who sustained injuries like fracture of hip bone with premorbid congestive cardiac failure with other chronic illness((Vieira, Sá, Madeira & Luz, 2014)

The sixth problem identified is high risk for recurrent falls due to previous fall at home.The seventh problem identified would be non-compliance to medications related to forgetfulness.The author identifies the two highest nursing problem priority through the clinical reasoning cycle. Using the clinical reasoning skills have shown positive results on patient outcome and those with poor reasoning skills often results in adverse patient outcome (Aiken, Clarke, Cheung, Sloane& Silber, 2003).

Collect cues/information Mr P, 84 year old man has a dressing to his right forehead where he received 8 stitches for a significant laceration from his fall. His vital signs was raised as charted on admission, BP is 142/88mmHg, HR is 110bpm, temperature is 37.3 degrees Celsius .Mr P, HNPU ever since admission. He has history of hypertension and congestive cardiac failure.

Process information: His blood pressure, heart rate is high and there is no urine output. His temperature is slightly raised but I am not too worried- I am concern about his high BP, high heart rate and no urine output. I would reassess vital signs and encourage 2 hourly potting. His high BP is high and it could be signs of intracranial cerebral haemorrhage .His raised BP could be due to intracranial pressure post fall with old age. Patient fall at home, raised heart rate and urine retention could be signs of impending septic shock.

Predict an outcome: If I don’t monitor vital signs hourly and call the doctor to order some anti-hypertensive's to lower the blood pressure and heart rate, the patient might have heart attack which can lead to death. The strain on your heart caused by untreated high blood pressure can cause the heart muscle to weaken and work less efficiently which can lead to sudden cardiac death (Dunn, Rudberg, Furner & Cassel, 1992).